-----Original Message-----
From: Gavin Mooney [mailto:[log in to unmask]]
Sent: Sun 10/13/2002 9:42 AM
To: [log in to unmask]; [log in to unmask]
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Subject: FW: sense and sensibility
Dear Barbara,
I hesitate to weigh in but...
1. Why would we think that there is, could be or should be some single
uniquely correct definition of equity. Whatever equity is, it is likely to
vary across cultures and societies.
2. Whatever it is, why would equity necesarily be defined solely in terms of
health? What about access?
3. It is implied in the definition that health is a construct that is common
across all cultures and societies.
4. Why do inequities have to be 'systematic'? Cannot for example an
individual general practitioner practice inequitably with respect to how she
treats her patients?
5. Why do inequities have to be 'potentially remediable'? Why can't they
just exist even if they cannot be remedied in reality or potentially?
This Declaration has a slight smell of WHO-World-Health-Report-2000 elitism
and universality.
There are some other strange ideas around the edges of this, such as that
equity should be lexicographically ordered, seemingly always and everywhere,
above efficiency. I will however restict my comments to the core.
Pursuing equity to me involves inter alia listening to the voices of those
who are currently suffering as a result of inequities (whatever they are).
Trying to decide for others, especially for the disadvantaged, which equity
definition they should adopt seems at best inappropriate and, by reducing
their autonomy still further, may actually create greater or new inequities.
I thus tend to the view that the Declaration venture is flawed, whatever
definition of equity were to be endorsed if that purports to be a universal
definition.
If some population group (say Aboriginal people) choose, on an informed and
rational basis, to use some health care resources to promote their health
(as they define it) which results in an increase in the gap between their
health and that of some dominant population, health now defined according to
the dominant culture's values (say western values), has inequity increased?
Or again, if the gap in health (as defined by western values) were to be
narrowed as a result of the dominant culture deciding how to allocate these
resources (but ignoring the preferences of the dominated culture), what
then?
I think the Toronto Declaration is at best unhelpful...except, and this in
my view is important, that it has stimulated some fascinating thoughts from
a number of interested and interesting parties.
Is it still possible for the Toronto Declaration to be Undeclared?
Warm regards
Gavin
Gavin Mooney
Professor of Health Economics
Director of SPHERe
Centre for International Health
Bldg 400
Curtin University
GPO Box U1987 Perth WA 6845
Australia
Phone 61 89 266 4304
Fax 61 89 266 2608
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